Cases Of Maternal Death Research Articles

Maternal mortality and its determining factors among hospitalised mothers in Tehran, Iran, 2013–2020

The maternal mortality ratio (MMR) is a significant indicator of the quality of a health care system. Despite considerable progress in reducing MMR in Iran in the past few years, we still face a long road ahead in eliminating preventable maternal deaths. In the present study, we evaluated all 80 cases of maternal deaths in 20 hospitals under the supervision of Tehran University of Medical Sciences between March 20 2013 and March 19 2020. During this time, these hospitals recorded 335,216 live births, with an MMR of 24 per 100,000 live births. The average age of deceased mothers was 31.9 ± 6.9 years. Direct causes accounted for 48.75% of maternal deaths, with haemorrhage being the most common direct cause of mortality (17.5%). Moreover, cancer (17.5%) and cardiovascular diseases (17.5%) were the most common indirect causes of maternal mortality. Even after accounting for the COVID-19 pandemic's effects, we have noticed an increase in maternal mortality. As a result, implementing a comprehensive approach for high-risk pregnancies is critical. Impact Statement What is already known on this subject? Although we have been able to reduce MMR in Iran to a reasonable level, previous measures would not be sufficient to accomplish future goals. Furthermore, we have a long way to go before reaching the ultimate goal of eradicating avoidable maternal deaths by 2030. What do the results of this study add? The causes, determinants and risk factors of maternal mortality were investigated in this study. With this level of detail, we can observe a steadily increase in MMR in recent years, regardless of the COVID-19 pandemic. The majority of pregnancy-related deaths can be avoided. What are the implications of these findings for clinical practice and/or further research? MMR reduction is a measurable goal that can be attained by improving financial resources, implementing safe delivery, team training, preparing multidisciplinary care with integration for high-risk pregnant women, establishing good provider relationships, and communicating with patients and providers for early warning signs and structural changes.

Relative Rate of Maternal Deaths in Pakistani Population due to sepsis

Aim: To investigate the relative rate of maternal deaths in Pakistani population due to sepsis including the most common causative agent. Methods: The proposed study was a retrospective study model which was mainly conducted at a tertiary care hospital of Lodhran district-Punjab, Pakistan from 2019-2021 in association with the cases of maternal deaths due to sepsis reported and observed at the Gynecology & Obstetrics department of different tertiary care hospitals. Total 1200 number of participants had been examined in this study and the convenient sampling technique was used. Whereas, it discusses the maternal mortalities due to different types of sepsis during, between, and after the delivery of a baby. with diagnosed 50% cases reported for the maternal deaths due to sepsis. Data was analyzed using SPSS VR 20.0 with level of significance being kept at P-value <0.001. Results:As per the observation, out of 1200 samples, 640 samples were culture-positive, including mixed culture growth. Highest percent positivity was showed up by Streptococcus pyogenes 640(53.33%), followed by Chlamydia psittaci 80(6.66%), Mycobacterium tuberculosis 120(10%), Escherichia coli 80(6.66%), Neisseria meningitidis 40(3.33%), and Epstein-Bar virus 40(3.33%). Different approaches of delivery, gender, and respiratory infections, and the time of admission to the hospital along with the qSOFA (Quick Sequential Organ Failure Assessment) Criteria were significantly associated with sepsis. ConclusionGroup A Streptococcus (i.e.Streptococcus pyogenes strains) were the most active causative agents 640(53.33%) in inducing maternal sepsis leading to deaths. Therefore, proper preventive measures should be taken before, during and after the delivery (antepartum, post-partum) to reduce the dependent and independent risk factors and subsequently to decrease the burden of maternal deaths due to sepsis. Keywords: Maternal, Sepsis, death, culture, Streptococcus pyogenes, GAS.

Eclampsia as the leading cause of maternal death at Prof. dr. R.D. Kandou Hospital, Manado, Indonesia

HIGHLIGHTS 1. One indicator of progress in a country's health is maternal mortality rate.2. The characteristics of maternal mortality were examined in a regional hospital in North Sulawesi, Indonesia3. Eclampsia was found to provide the most contribution to maternal mortality cases in the hospital. ABSTRACT Objectives: To determine the characteristics of maternal deaths at Prof. dr. R.D. Kandou Hospital, Manado, Indonesia, from January 1 to December 31, 2019. Materials and Methods: This was a retrospective descriptive study. Data were taken from the patient's medical record at Prof. dr. R.D. Kandou Hospital, Manado, in the period of January 1, to December 31, 2019. Results: From January 1 to December 31, 2019 in Prof. dr. R.D. Kandou Hospital, Manado, there were1.215 single live births, with maternal mortality of 22 cases. In the distribution of characteristics based on age, most patients had age range of 20-34 years with a total of 15 patients (68.18%) and parity 2 - 4 with a total of 21 patients (95,45%), Antenatal Care (ANC) of 1 – 3 times visit in a total of 11 cases (50%), and most came from outside the city of Manado with a total of 12 patients (54.54%). The most common cause of maternal death was due to eclampsia, comprising 8 cases (36.36%). Conclusion: Maternal death cases in Obstetrics and Gynecology Department of Prof. dr. R.D. Kandou Hospital, Manado, Indonesia, in 2019 reached 22 cases per 1.215 live births. Eclampsia was still the leading cause of maternal death.

Nine Maternal Mortalities in 2 Weeks of Second COVID-19 Surge in Indonesia: A Case Series from One Large Tertiary Center

BACKGROUND: The fluctuating COVID-19 cases among the pregnant women’s population encountered increased of cases and maternal mortality. AIM: This research aimed to describe the case of maternal deaths caused by COVID-19. CASE REPORT: We present nine serial cases of maternal death caused by COVID-19 who were admitted to Dr. Soetomo General Academic Hospital for 14 days in June. We found 32 positive COVID-19 obstetric cases and reported nine maternal deaths with a fatality rate of up to 28%. Seven of nine patients had reverse transcription-polymerase chain reaction–confirmed SARS-CoV-2 infection, while two had a positive antigen swab. Half of the patients ≥35 years old, and five of nine patients had Class I obesity as preexisting comorbidity. This study reported the death of pregnant woman at their 2nd trimester and 3rd trimester presenting infected by severe COVID-19. The usual symptoms are dyspnea, cough, fever, and decreased consciousness. The result of chest X-ray examination among eight patients showed bilateral pneumonia. Most of cases were referrals from a secondary hospital due to overload hospital capacity. Three patients were directly transferred to the tertiary hospital without receiving initial treatment. Eight of 9 patients (88.9%) were transferred to intensive care unit and intubated due to low oxygen saturation. CONCLUSION: In conclusion, the limited hospital facility and lack of intensive care capacity for obstetric cases during the second wave of the COVID-19 pandemic may enhance the probability of mortality and morbidity in pregnant women infected by COVID-19.

Isolated Tubal Torsion in a Term Pregnancy: Case Report and Systematic Review of Literature of the Last 10 Years.

ObjectiveIsolated torsion of a fallopian tube is a rare event and it is extremely difficult to be diagnosed in pregnancy. The aim of this study is to present a clinical case report that occurred in our department and to summarize the latest evidence about tubal torsion in pregnancy.MethodsWe reported data, ultrasonographic features and an intra-operative image of a case report of tubal torsion in a term pregnancy. Then a review of the literature was performed following the PRISMA statement: we searched all the articles related to tubal torsion in pregnancy in the last 10 years from the international electronic bibliographic database PUBMED. We collected data regarding population characteristics, clinical features, treatment, and feto-maternal outcomes.ResultsAccording to our search strategy, 10 articles were included. The main clinical symptoms were abdominal pelvic pain (100%), nausea, and vomiting (30%). The mean gestational age at the diagnosis was 36 weeks after the last menstrual period in 50% of cases. Ultrasound images showed a cystic lesion in the adnexal area in 70% of cases. In most of the cases, a cesarean section with a contextual salpingectomy was performed. No cases of maternal and fetal death were respectively reported.ConclusionIsolated torsion of the fallopian tube is a rare obstetric condition but it should be considered in case of acute lower abdominal pain presentation during pregnancy. Depending on gestational age, surgical treatment as soon as possible could prevent a salpingectomy.

Reducing Mortality and Morbidity in Morbidly Adherent Placenta

Objectives: The goal of this study is to explore methods for minimizing mortality and morbidity in the context of a morbidly adherent placenta. Study Design: A descriptive observational case series. Place and Duration: This is two-year study was held in the Obstetrics and Gynecology department of Khyber Teaching Hospital Peshawar from January 2018 to January 2020. Methods: There are 36 females included in this study who have morbidly adherent placenta. The surgical procedure, antenatal diagnosis, quantity of blood loss, organ damage, blood transfusion, hospitalization, ICU and postnatal problems are all evaluated in these patients. SPSS version 21 was used to analyze and evaluate the data. Results: Ultrasound and colour Doppler were used to diagnose 30 patients antenatally. Six of them were revealed during surgery, nine of them had a severe hemorrhage, and five to ten units of blood were transfused. Three of the undiagnosed patients suffered a bladder injury, ten were admitted to the hospital, and two required ventilator support. In 26 patients, hysterectomy was performed, while four patients had conservative surgery. There were no cases of maternal or newborn death. Conclusion: Mortality and Morbidity may be reduced by increasing the index of suspicion, performing prenatal diagnostics, anticipating large volume blood transfusions, and performing planned hysterectomy with a fundal classical incision without disturbing the placenta. It is important to be aware of the possibility of a morbidly adherent placenta, just as it is important to be aware of other obstetric crises. Keywords: previous C-section Scar, morbidity, mortality, hysterectomy, morbidly adherent placenta

Study Factors Involved in Maternal Deaths Attributed to COVID-19 in a Disadvantaged Area in Southeast of Iran.

Objective: It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women. Materials and methods: This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis. Results: From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth). Conclusion: The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.

Evaluation of the quality of maternal death review cycles in Burkina Faso.

To assess the quality of the maternal death review (MDR) cycle in selected health facilities in Burkina Faso in accordance with national standards. A multiple case study using a qualitative approach performed in five health districts and two regional hospital centers in Burkina Faso. The facilities were chosen by contrasted purposive sampling based on hospital maternal mortality rate and urban or rural location. Structured and semistructured interviews were conducted and data analyzed thematically, horizontally, and vertically. Of the seven facilities included, six performed MDR. The MDR cycle was incomplete in five facilities because the implementation of recommendations had not been assessed. All cases of maternal death lacked vital information. Case analysis was not conducted in accordance with the national standards in most of the facilities. The action plans for implementing recommendations were not commonly used. The MDR process and its various stages did not meet quality standards. Identifying the determinants leading to lack of adherence to MDR standards will contribute to optimal choice of interventions and improving good practices in health facilities.

Висока легенева гіпертензія і вагітність

Метою проведеного дослідження було вивчення перебігу та результатів вагітності у пацієнток з високою легеневою гіпертензією. Наведені власні спостереження 14 вагітних жінок з високою легеневою гіпертензією, а також проведено аналіз експертних і літературних даних. Проаналізовано ефективність різних способів лікування і розродження цих жінок. З 14 пологів, що відбулися, шість були передчасними (42,9 %). У пацієнток, які спостерігалися нами, кесарів розтин було зроблено в 64,3 % випадків, пологи через природні родові шляхи відбулися в 35,7 % випадків. У стані асфіксії тяжкого ступеня народилося 21,4 % дітей, помірного — 35,7 %. Частота гіпотрофії плода при високій легеневій артеріальній гіпертензії склала 57,1 %. Не було жодного випадку материнської та перинатальної смертності.

Etude rétrospective sur 70 cas d'hystérectomie d'hémostase dans le département de gynécologie obstétrique de l'hôpital de Ben Arous, Tunisie

Introductionl´hystérectomie d´hémostase constitue le traitement radical de l´hémorragie du postpartum. Notre objectif était d´étudier les facteurs de risque, les indications et les complications de l´hystérectomie d´hémostase et de déterminer les facteurs influençant le choix du type d´hystérectomie.Méthodesnous avons mené une étude rétrospective monocentrique descriptive et analytique dans le service de gynécologie obstétrique de l´hôpital régional de Ben Arous de 2003 jusqu´à 2019. Les patientes ont été classées selon le type d´hystérectomie totale ou subtotale.Résultatssoixante-dix patientes ont été incluses. Le taux d´hystérectomie d´hémostase était de 1,3‰. L´âge moyen était de 34,5 ans (± 5,1). Les indications d´hystérectomie d´hémostase étaient dominées par le placenta accréta dans 39% des cas (n=27), l´inertie utérine dans 34% (n=24) et la rupture utérine dans 16% des cas (n=11). Le taux de morbidité peropératoire était de 34% (n=24). Les complications les plus fréquentes étaient l´état de choc hémorragique dans 17% (n=12), la coagulation intravasculaire disséminée dans 6% (n=4) et les lésions vésicales dans 6% (n=4). Nous avons déploré six cas de décès maternel soit 8% (n=6). Une hystérectomie subtotale était réalisée chez 79% patientes (n=55) et 21% des femmes (n=15) ont eu une hystérectomie totale. Le placenta accréta était associé de manière significative au groupe hystérectomie totale (ORa: 6,93, IC 95%: 1,07-44,80, p=0,042) et la durée moyenne de l´opération était significativement plus courte en cas d´hystérectomie subtotale (ORa: 1,023, IC 95%: 1,009-1,03, p=0,01).Conclusionl´hystérectomie est indispensable précisément dans certains cas d´hémorragie sévère du post partum. Le placenta accréta représente la principale indication d´hystérectomie. L´hystérectomie totale n´est pas associée à un risque accru de complications par rapport à l´hystérectomie subtotale.

Anemia in Parturients within the Mother-Child Department of Tengandogo Teaching Hospital, Burkina Faso

Objective: Study the epidemiological, clinical, para-clinical and therapeutic aspects as well as the maternal and perinatal prognosis of anemia in parturients. Background: Anemia is a public health problem in Burkina Faso. It mainly affects pregnant women. Patients and Methods: This was a descriptive and analytical cross-sectional study with prospective data collected from January 1st to September 30th, 2021. The study population included all parturients received within the department. Results: We included 378 parturients. We included in our study, all the parturients who underwent blood count upon admission and who had a hemoglobin rate below 11 g/dl. The frequency of anemia was 35.9%. The average age of anemic parturients was 27 ± 6.3 years. Compliance with anemia preventive treatment was good in 63% of cases. Out of the 378 anemic parturients, 55.8% were delivered by cesarean section. At delivery, 21 stillbirths were recorded. The mean hemoglobin level on admission was 9.27 g/dl ± 1.6. Normochromic microcytic anemia was present in 50.7% of cases. We recorded 1 case of maternal death (0.2%). The perinatal mortality rate was 7.4%. Conclusion: Despite the government’s efforts, anemia in pregnant women remains a public health problem in our country. This reality calls on decision-makers to lay emphasis on measures to prevent anemia in pregnant women.

Case series of maternal mortality and maternal near miss due to severe acute respiratory syndrome coronavirus 2

The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes the COVID-19 pandemic has affected every household of the remotest part of North East India, Mizoram. The pregnant women do not have a higher chance of getting infected, yet the infection seems to be more severe. We are reporting five cases of maternal death and two cases of maternal near miss in ZMC of Mizoram. Case 1 to 5 were maternal death due to COVID-19. All of them were multigravida within the age group of 27–41 years with a period of gestation 24–37 weeks. The presenting complaints were fever and cough more than 3 days with an investigation report revealing raised C-reactive protein (CRP) and severe pneumonia. Case 6 (Near miss) was 20 years, primigravida at term pregnancy in labor with a history of fever for 2 days with an investigation report revealing raised CRP and severe pneumonia, the baby was delivered asphyxiated and died. Case 7 (Near miss) was 17 years old primigravida at term pregnancy admitted as asymptomatic COVID-19 positive, elective caesarean section was done for Obstetrics indication, the patient later developed fever and moderate pneumonia on 5 days of hospitalization, she also developed eclampsia on 7th hospital day, she survived after intensive care in the intensive care unit.

An Insight into Maternal Deaths: A Retrospective Analysis and Pathologists Perspective in Series of 16 Autopsy Cases

Introduction: Maternal mortality continues to be of great concern with most maternal deaths occurring in developing countries which accounts for about one in 180 deaths during childbirth as compared to 1 in 4,900 in developed nations. Aim: To determine the common causes of maternal deaths and to study their clinicopathological profile. Materials and Methods: The present study included series of 16 cases of maternal deaths from January 2018 to June 2020. The study was conducted at Indira Gandhi Medical College, Nagpur, Maharashtra, India. The post mortem examination in all these deaths was conducted as per institutional policy. The external, in-situ examination along with histological findings are studied in each case. Results: The study group comprised of 16 cases, in the range of 21 to 37 years with a mean age of 27 years. Nine deaths were in antepartum, while seven in postpartum period and all the deliveries took place in hospital. Amongst these 16 deaths, 11 were brought dead while in rest five, deaths were hospital based. Conclusion: The autopsy provides an invaluable information and insights about pathophysiological changes and sequence of events leading to death. Usefulness of relevant clinical data in complementing the diagnosis cannot be overemphasized. Their in-depth analysis can certainly help to prevent future maternal deaths and also in early picking up of complications; which further can avoid this preventable and inevitable loss and reduces the national burden on maternal mortality.

Clinical Analysis of Four Maternity Deaths in Iraq by COVID-19


 This study aims to identify maternal death cases caused by Coronavirus infection 2019 pneumonia, including disease progression, fetal consequences, and the fatality cause.
 Patients and methodology: A retrospective case collection of Iraqi pregnant women in their second and third trimesters diagnosed with COVID-19 pneumonia and died due to it.
 The four cases were all of a young age, had a brief complaint period, and had no comorbidities. Fever, dyspnea, and fatigue were the most common symptoms. Hypoxia was present in all cases and was the cause of mortality in three cases, with thromboembolism being a potential cause in the fourth. Prelabour membrane breakup, fetal growth restriction, and fetal death are all examples of adverse fetal effects.
 Conclusion: COVID-19 pneumonia induces substantial fetal and maternal mortality rates through pregnancy, which should be considered when treating these cases.

A Case of Postpartum Maternal Death with COVID-19 in the West of Iran

Introduction:: There are a limited number of studies about COVID-19 during delivery and postpartum. Case presentation:: A 38 -years- old G3p2 woman at 35 weeks and 4 days of gestation was referred with the chief complaints of dyspnea, cough, headache, and fever. Pharyngeal swab polymerase chain reaction (PCR) was negative for COVID-19; however, in chest Computed Tomography (CT) angiography, ground glass was observed in the basal lobe of the left lung. The infant was born via cesarean section with a gestational age of 36 weeks and an Apgar score of 8/9. No infant document was found about COVID-19 and other infections in several days after delivery. The patient died eight days after the onset of symptoms due to cardiovascular collapse. Discussion:: we reported the first death of a postpartum maternal with COVID-19 and a healthy baby with no evidence of COVID-19 and a gestational age of 36 weeks. Conclusion:: Physicians should be aware that pregnant women with symptoms of respiratory infection and pulse negative PCR test should be followed for infected with COVID-19. This infection may be led to maternal death.

Analysis of prevalence and sociodemographic conditions among women in labor with and without COVID-19 in public hospitals in Chile.

The SARS-CoV-2 virus continues wreaking worldwide havoc on health and between March and August 2020, the first outbreak of COVID-19 hit Chile. The pregnant population is especially vulnerable to infection. Studies have been published that associate socioeconomic status, overcrowding, and poverty with a higher prevalence of SARS-CoV-2 infection. There are few studies about the development of this pandemic in Latin American countries so far. This study seeks to show the prevalence and sociodemographic and perinatal characteristics in pregnant women at the time of delivery, comparing both groups with positive and negative COVID-19 PCR results. A prospective, cross-sectional study of pregnant women who delivered at the San Juan de Dios Hospital in Santiago between April 15, 2020 and June 15, 2020. Analysis of epidemiological, sociodemographic, obstetric, perinatal and sociodemographic data of patients with positive and negative COVID-19 PCR results. There were 701 patients included in the study. The prevalence of those with a positive COVID-19 PCR was 9.7% and 67.7% being asymptomatic. Pre-term delivery was significantly higher in the group of positive patients (23.5%) vs. negative patients (8.7%), which was not the same rate as with cesarean sections (C-sections). A 13.2% of patients required management of the pathology in the Critical Care Unit (CCU) and there were no cases of maternal or fetal deaths. We found no significant difference between both groups when analyzing socioeconomic variables, though we noted a trend of greater overcrowding among the group of patients with infection. The majority of pregnant patients with SARS-CoV-2 infection are asymptomatic. COVID-19 increases the rate of premature births, but this rate is not same with C-sections. Sociodemographic conditions and overcrowding do not show a higher infection rate in a homogeneous population in relation to the economic, social and demographic level.

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury.

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

Maternal Perinatal Characteristics in Patients with Severe Preeclampsia: A Case-Control Nested Cohort Study.

Preeclampsia is one of the most worrisome complications during pregnancy, affecting approximately 1 out of 20 women worldwide. Preeclampsia is mainly characterized by a sustained hypertension, proteinuria, also involving a significant organ dysfunction. Moreover, 25% of the cases could be classified as severe preeclampsia (SP), a serious condition that could be life-threatening for both the mother and fetus. Although there are many studies focusing on preeclampsia, less efforts have been made in SP, frequently limited to some specific situations. Thus, the present study aims to conduct a comparative analysis of risk factors, maternal characteristics, obstetric and neonatal outcomes and maternal complications in patients with severe preeclampsia versus patients without severe preeclampsia. Hence, 235 cases and 470 controls were evaluated and followed in our study. We described a set of variables related to the development of severe preeclampsia, including maternal age > 35 years (69.8%), gestational (26.8%) or chronic arterial hypertension (18.3%), obesity (22.6%), use of assisted reproduction techniques (12.3%), prior history of preeclampsia (10.2%) and chronic kidney disease (7.7%) All patients had severe hypertension (>160 mmHg) and some of them presented with additional complications, such as acute renal failure (51 cases), HELLP syndrome (22 cases), eclampsia (9 cases) and acute cerebrovascular accidents (3 cases). No case of maternal death was recorded, although the SP group had a higher cesarean section rate than the control group (60% vs. 20.9%) (p < 0.001), and there was a notably higher perinatal morbidity and mortality in these patients, who had a prematurity rate of 58.3% (p < 0.001) and 14 perinatal deaths, compared to 1 in the control group. Overall, our study recognized a series of factors related to the development of SP and related complications, which may be of great aid for improving the clinical management of this condition.

Maternal mortality: structure and solutions to the problem

Maternal mortality is the most important indicator of womens health, but its level is still high. In 2018, 146 cases of maternal death were registered in the Russian Federation. Its main causes were extragenital diseases, bleeding, preeclampsia and eclampsia, amniotic fluid embolism, clinical narrow pelvis, and unsafe abortion. The aim of this study was to assess the structure of maternal mortality in recent years and to evaluate possible ways to reduce it. This was achieved by using an analytical method including carrying out a detailed systematic analysis of modern domestic and foreign literature on the maternal mortality issue. The study used databases such as eLIBRARY.RU, Scopus, PubMed, MEDLINE, ScienceDirect, and Cochrane Library from the creation until July 2021. The measures adopted so far do not allow for counting on a further decrease in maternal mortality rate, therefore the coming decade requires the introduction of artificial intelligence technologies.

A hospital-based assessment of the complications of caesarean section during second stage of labor: An observational study

Aim: To evaluate the maternal and neonatal outcome of caesarean section in second stage of labour. Material and Methods: This observational study was carried out in the Department of Obstetrics and Gynecology, Mamata Academy of Medical Sciences, Bachupally, Hyderabad, India, for the period of 1 year. Total 200 patients were included into the study. All caesarean sections performed at full cervical dilatation over this time period. Results: Among the 200 patient’s majority of them were in the age group of 20-30 years (73.5%). about 77.5% of the patients were primigravidae and only the remaining 22.5% were multigravida. 82.5% of patients from BPL socioeconomic class and 17.5% only from APL socioeconomic class. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH was 27 out of 200 cases (13.5%). Post-operative wound infection was seen in 12(6%) and post-operative fever was seen in 32(16%) out of 200 cases. There were no cases of maternal deaths reported. The mean operative time was 51.7 min. The mean length of hospital stays was 6.8 days. Mean weight of the babies of the second stage caesarean section was 3.4 kg. 11 (5.5%) babies were admitted to the Neonatal Intensive Care Unit and 26 (13%) to neonatal nursery for management of respiratory distress, sepsis, jaundice, and observation. 25 (12.5%) babies had Neonatal jaundice and There were 2 neonatal deaths reported. Conclusion: Caesarean sections during the second stage are increasing in prevalence and are associated with significant long-term psychological and physical maternal morbidity.